Before you begin, explain to your child that clean-up time is part of the artistic process.

Set out a sponge so your child will be ready to help with any spills. You will both find projects more relaxing if you can clean as you work. More tips:

Give your child a kid-sized broom and shovel.

Keeping a dedicated plastic work mat handy helps keep art projects under control and teaches your child the good habit of careful set up before using art materials.

It is best to have one for each person, including you.Use water-soluble and washable markers.

To clean stray crayon marks, try washing with warm water or a diaper wipe.

Facility owners and managersalsolearned that banks had final decision-makers whom they might never meet; they related only to the local loan officer (analogous to a salesperson), who would turn over the files to analysts and underwriters, who would then make the final decision on the loan and specific terms. So, educating the loan officer did not always guarantee the ideal end result.

Many of those surveyedsuggested starting early and using local professionals (lawyers, accountants) and senior business executives for high-level bank introductions. All recommended working with more than one bank, and several strongly suggested keeping two banking relationships at all times, with at least 80 percent of the company’s assets placed with one bank.

Many club owners found that there were a series of elements of a loan that could be negotiated (collateral, up-front points, personal guarantees, prepayment penalties, covenants, etc.).

Several smaller clubs suggested that graduating from a SBA loan (or SBA-guarantee) was significant.
All agreed that refinancing was worthwhile, and often ideal when the overall business climate was somewhat unfavorable.

Yet even with improvements in mammography over the years, many tiny tumors are still barely visible. As mentioned, part of the answer relates to the density of the breast tissue being imaged.

In pre-menopausal women, the tissue of milk production pervades the breasts and appears opaque, or white, on a mammogram. Unfortunately, so do tumors. In post-menopausal women, breast tissue gives way to fat, which mammographically appears grayish. Thus, tumors — no matter their size in post-menopausal women — show up in sharp contrast to fatty tissue, making the tumors much more visible to the diagnostic radiologist.

CAD, its developers say, helps ensure against human error by directing radiologists’ attention to obscure tumors and microcalcifications, the potentially pre-cancerous deposits that sometimes can be overlooked.

“The next challenge for CAD is diagnosis,” Doi said. “We have already developed algorithms that guide our system in distinguishing benign from malignant lesions. I believe that in time, as we fine-tune these algorithms, CAD will also become an important tool in helping women avoid unnecessary biopsies.”

Even with computer-enhanced detection of tiny tumors on mammograms, doctors say there is still a need for tests that focus on biomarkers. With respect to breast cancer, a biomarker would be any chemical or cells in the blood, tissue or other fluid that would signal impending cancer development. Such tests, doctors say, could potentially be far more precise than mammography in revealing evidence of cancer’s building blocks. The hope is that these building blocks would be detected years before a tumor ever begins to develop.

Researchers at the University of Nebraska in Omaha, for example, are working on a potential biomarker test for breast cancer that targets metabolites of estrogen. Lifelong exposure to estrogen is a long established link to increased breast cancer risk. While scientists are still uncertain exactly why estrogen exposure boosts the risk for breast cancer, some scientists hypothesize that metabolites — breakdown products of estrogen — might trigger DNA mutations, leading to tumor formation.

Dr. Douglas E. Stack and colleagues at the University of Nebraska are studying ways to detect these metabolites. Though the research is still in its early stages, if the scientists are successful, an effective biomarker for the early detection of breast cancer will be created. Screening could eventually become as simple as any standard blood test.

Ideas for new methods of screening and early detection abound.

Another potential test is minimally invasive and involves sampling cells from the same breast ducts over time in women who are at high risk for breast cancer, either as a result of personal history of breast cancer or inheritance. For years scientists have known that most breast cancers begin in the ducts. However, there was no way of sampling cells within the ductal system.

Famed breast surgeon and author Dr. Susan M. Love may have found a way. She is leading a study at the University of California, Los Angeles that has mapped the ductal system of the breast and has also developed a device that is minimally invasive and capable of retrieving ductal cells.

“With this device we can find cells that are just thinking about becoming cancer,” said Love, author of “The Breast Book,” an international bestseller.

Despite all of the work-in-progress, Visco sounds a note of reality. Though she and others would like to see the use of biomarker-testing and minimally invasive diagnostics, “mammography is the best we have right now,” she said.

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And even if mammography must stick around, women ask if there is a way to make it more precise.

There have been many instances in which mammography has failed to detect tumors in those with dense breast tissue. Because tumors and the dense breast tissue of younger women both appear white on a mammogram, doctors sometimes miss cancers-in-development.

As it turns out, there is progress on multiple fronts to improve screening and diagnostics for breast cancer.

Computer technology is being developed to improve the use of mammography. Further down the road, minimally invasive tests, which are being researched, will seek out biological markers for breast cancer in blood or other fluids long before a tumor takes hold. With an emphasis on biomarkers, doctors say, mammography could become a technology of the past.

“Mammography does not detect all breast cancers and it cannot distinguish well among the various kinds of breast cancer,” said Fran Visco, president of the National Breast Cancer Coalition, an advocacy group for breast cancer patients with headquarters in Washington. What Visco and other advocates would like to see is a screening technique that is more precise and ultimately eliminates the use of radiation.

At the Era of Hope breast cancer conference held recently in Atlanta, researchers presented data on the progress of computer-aided diagnosis, or CAD. The meeting attracted hundreds of scientists, doctors and patient advocates, and was sponsored by the U.S. Department of Defense’s breast cancer research program.

CAD does not eliminate the use of radiation in screening, but it provides enhanced computerized pictures of breast tissue already imaged mammographically. The technology can help doctors spot early-stage breast cancers, which might otherwise go undetected. It works this way: At a CAD workstation, a laser scanner is used to transform the mammography film into a detailed matrix of digital data. Precision-driven computer programming guides the system’s vision and artificial intelligence to scan the digital matrix. In so doing, it can sift out background images, such as those of normal soft tissue, and emphasize patterns that are most likely to be cancerous lesions.

Suspect areas highlighted by the program are instantly and automatically flagged with arrows. This is what can draw a radiologist’s attention to unusual patterns in a new way, doctors say.

“CAD cannot pick up lesions that are invisible to mammography, but it can compensate for some cases of radiologist oversight,” said Dr. Kunio Doi, professor of radiology at the University of Chicago. “We believe the increasingly positive results with CAD demonstrate it can serve as a ‘second opinion’ for traditional screening mammograms.”

Under a contract from the University of Chicago’s Defense Department grant, radiologists there are now using CAD as a second opinion in a study of all screening mammograms conducted at one Illinois diagnostic radiology facility. Doi and his team of researchers will analyze data from that study after information has been collected for about two years. At that point they will determine whether CAD indeed helps improve detection of breast cancer. Positive results from the study could help speed CAD into more generalized use, researchers say.

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NCPA (The National Community Pharmacists Association) and NACDS (The National Association of Chain Drug Stores), which collectively represent more than 55,000 community pharmacies and 130,000 pharmacists, allege that the administration violated federal rules by failing to hold public hearings and by setting standards for the program in secrecy.

The complaint, filed in US District Court in the District of Columbia, attacks the administration’s drug discount plan over the “unlawful” way it was allegedly developed and over aspects of the program itself that the groups say violate federal law.

President Bush’s Medicare drug plan, unveiled last week, allows seniors to sign up with private companies to get cards bearing the Medicare logo that will enable them to receive discounts of up to 25% on prescription drugs. Pharmacy benefit managers (PBMs) will negotiate the discounts and administer the program.

“The whole business of the Medicare program — the sacrosanct Medicare program — and even the utilization of the name Medicare has been handled with kid gloves since 1965, and any time a private entity was involved in Medicare, it was explicitly authorized by Congress,” said John Rector, the NCPA’s general counsel. “What you have here is quite the opposite,” he told Reuters Health.

The groups contend that the Department of Health and Human Services (HHS) illegally delegates all power to a private company by having the PBM consortium create, administer and enforce standards for the program.

The complaint, which names HHS Secretary Tommy Thompson and Centers for Medicare and Medicaid Services Administrator Thomas Scully, seeks to block the discount program from taking effect.

HHS spokesman Bill Pierce declined to comment on the suit, but reiterated the administration’s contention that the program is a “first step” aimed at helping potentially 40 million seniors get access to drug discounts.

“What this issue is about is providing seniors with immediate relief that many other citizens have access to, including many of their fellow seniors, on an issue–high prescription costs–that they want action on,” Pierce told Reuters Health.

But NCPA’s Rector suggested that the program is designed by the PBMs to feed their own mail order programs. He said pharmacies make a net profit, on average, of just 1% to 2% on prescriptions, while the Bush plan promises drug discounts of 15% to 25%.

“There’s no way any online pharmacy could be forced to take that kind of discount and survive,” he insisted. “So in a way it’s built to assure that the people who get the card go to the mail order programs.”

“This plan provides false hopes to our seniors when they walk into their neighborhood pharmacy,” added Craig Fuller, president and CEO of NACDS. “The possibility exists that there are no real discounts on the drugs that their doctors prescribe, their pharmacy does not participate in the plan, or that they must take a different type of medication than that which was prescribed by their doctor.”

A number of interest groups have raised concerns about the drug plan, but pharmacy groups are among the program’s fiercest critics. On Tuesday, members of Congress joined representatives of pharmacy groups in opposing the plan.

At congressional hearings on Thursday, HHS Secretary Tommy Thompson told Reuters Health that he was not surprise by the lawsuit and that it will not slow down the administration’s goal of offering the discounts by January 2002.

“I’ve looked at the lawsuit and I think that we are on very strong grounds,” he said.

A reputable coach or sports instructor:

* Is diversified in his/her teaching skills.

* Is certified to ensure members are provided the best, consistent, quality instruction.

* Is personable, patient and provides eye contact.

* Creates an environment that makes participants feel excited instead of intimidated.

* Helps participants set realistic goals for a positive, successful experience. This builds confidence to tackle more difficult skills, more challenging terrain, etc., without fearing failure.

* Always listens attentively.

* Uses “transfer of learning” to find out what other activities members participate in and relate as much as possible to those past, positive experiences. For example, if a member has experience playing racquetball and is taking tennis lessons, you’ll draw on those experiences to enhance the lesson.

* Teaches logical and safe movement progressions, ensuring the mastery of one skill to make the next easy to learn, and explains directions with demonstrations, checking for understanding, giving time to practice, offering immediate feedback, checking again for understanding, demonstrating again, practicing again, and reviewing what was learned.

* Possesses “kinesthetic empathy” to feel physically and relate mentally to what members are going through; instructors with empathy communicate respect for their members and get respect in return.

* Gives lots of positive reinforcement.

* Gives handouts, “homework” and resources to reinforce what members have learned.

* Always has participants sign a release of liability or waiver; members are educated to question the professionalism and background of an instructor who doesn’t.

The result is the Equipment Cleaning Program, which involves the facility’s entire staff in a teamwork effort to keep the facility’s 200 machines clean and in good working order. Each month, the equipment inventory is divided evenly among staff members who are required to clean equipment at least twice a week. Equipment assignments are changed monthly, with the staff member achieving the highest equipment rating being excused from cleaning duty for the next quarter. Staff is held accountable for weekly cleanings by recording dates in a log book, and by weekly equipment checks made by supervisors. At the end of the quarter, if the staff has a collective average evaluation of “good” or better, a party is held at a staff meeting, with management providing refreshments.

Since the program was created in March 1996, the number of negative comments about equipment maintenance has dropped to their lowest to date, and, last year, maintenance requests dropped from 42 in January to 12 in December. By using a team approach and available resources, costs were kept to only cleaning supplies and refreshments for staff parties.

“Prospective members comment often during tours of the club that our facility is very clean compared to other places they have visited,” says Siegfried’s Juli Atkinson. “This promotes our reputation for health and wellness and the likelihood they will choose to join our facility.

The report, which appears in the May 15 issue of the journal Cancer, covers cancer incidence (the number of new cases) and mortality from 1973 to 1997. While an increase in overall cancer incidence occurred between 1973 and 1992, this trend turned downward after 1992. Cancer death rates followed a similar pattern, dropping since 1991, with an even sharper decline since 1995. Researchers reported the greatest declines in cancer incidence were among men. Men, however, also suffer higher rates of cancer than women.

The report highlighted trends in lung, prostate, breast and colorectal cancer, as these malignancies make up more than half of all new cancer cases and are the leading causes of cancer mortality in the United States.

Overall rates of lung cancer, the No. 1 cause of cancer-related deaths in the United States, have fallen since 1991. This decline is largely due to the reduction in lung cancer incidence and death among men. In women, however, lung cancer mortality rates are on the rise. Public health experts attribute this trend to the prevalence of cigarette smoking among women. It is estimated that cigarette smoking causes almost 90 percent of lung cancers.

“The lung cancer trends are all directly related to smoking patterns,” said Phyllis Wingo, Ph.D., an epidemiologist and director of surveillance research with the American Cancer Society. “Men took up smoking earlier in the century and they also began to quit smoking earlier,” she explained. According to Wingo, the trends in smoking among women are expected to follow those of men. But, Wingo argued, “the increase in tobacco use in youth is really the bigger problem. They represent the next lung cancer epidemic unless we’re able to turn these rates around.”

Researchers noted that rates of prostate cancer incidence and mortality are both dropping. And contrary to some claims of a breast cancer epidemic in the United States, the latest report shows no increase in breast cancer incidence over the past decade, and a decline in breast cancer deaths since 1990. This decline is likely due to earlier detection of breast tumors with mammography, as well as more effective treatments for the disease.

The report carried a special section on colorectal cancer, which has also seen overall declines in mortality and incidence. Researchers found, however, that during the time period examined, screening rates for this cancer were low.

Commenting on the recent government report, Gilbert L. Ross, M.D., medical director of the American Council on Science and Health, said, “The public encounters a constant barrage of doomsday claims that cancer rates are skyrocketing. Hopefully, this latest report will calm Americans’ unfounded fears of a ‘cancer epidemic.’”

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With MRI, radio waves and magnetism are used rather than the x-rays utilized by CT (computed tomography) scans. This produces thin “slices” of anatomy for doctors to evaluate.

MRI’s produce clearer images of soft tissues (including muscle, brain, joints, internal organs, fat) that CT and do not use ionizing radiation.

MRI was introduced to the medical community in the 1980′s following the revolutionary advances of computed tomography (then computed axial tomography or CAT scan) in the 1970′s. In the next few decades its use will become more commonplace as will its applications for animals.

One of the first tasks in diagnosing ADHD is to gather enough information to rule out other possible causes of the child’s aberrant behavior. Another prong is assessing the child’s intellectual, academic, social, and emotional functioning.

Most mental-health practitioners and educators are adept at spotting situations, such as inadequate teaching techniques, that can provoke a normal child into acting as if he or she had ADHD. For example, there have been cases where a child’s inattentiveness disappears when a teacher gives a child more praise or simply seats him in the front of the classroom.

Fear, bereavement, child abuse, mild seizures, learning disabilities, and a variety of mental disorders can make a child seem hyperactive, impulsive, or inattentive, even if they do not have ADHD. Class work that is too easy or too hard can lead to boredom, inattention, or hyperactivity at school. Medical conditions, such as chronic ear infections or undiagnosed visual impairment, can produce ADHD-like behaviors. But such children are showing the effects of other problems, not ADHD.

While parents may have strong instincts about their own offspring, only a licensed mental-health professional or other specially trained health-care provider is qualified to distinguish ADHD from other disorders or from normal growing pains.

Diagnosing ADHD in adults

Your performance at home and work will help determine whether you have an attention deficit disorder. If your parents are alive, they may be asked to rate your behavior as a child. To help rate current behaviors, the specialist may ask your spouse or roommate to fill out a rating scale. But it is your self-assessment that is most important. Perhaps you feel frustrated most of the time because you feel you are not able to make the most of your intellectual potential. You may also feel restless and easily bored. Some adults with ADHD describe themselves as excitement-seekers. Frequent job changes among these individuals is not unusual. According to the NIMH, most adults with an attention deficit disorder can recall incidents throughout their lives when they were inattentive, impulsive, overly active, impatient, or disorganized. According to CHADD, by learning to channel their energy creatively, adults with attention deficits can flourish in the workplace. For example, many adults with attention deficits become successful entrepreneurs.

Who diagnoses ADHD?

Unless the parent has already had the child evaluated for ADHD during the preschool years, a kindergarten teacher may be the first person to recognize a potential problem in your child. In such cases, the teacher generally requests parental permission to refer the child for a formal evaluation. The evaluation may be performed by a school psychologist or by a team including the school psychologist and other specialists. Parents also have the option of consulting the child’s pediatrician or family practitioner, who may do the evaluation personally or refer the child to a child psychiatrist, psychologist, neurologist, or other specialist. State and local social service agencies as well as ADHD groups can help you find an appropriate specialist to evaluate your child.

Adults who believe they have an attention deficit disorder can consult a psychologist, psychiatrist, or neurologist. Unfortunately, according to the National Institute of Mental Health (NIMH), not all mental-health specialists are skilled in identifying or treating attention deficit disorders in adults. Before scheduling an appointment, ask whether the practitioner has specific training and experience with in adults with ADD. Or ask members of a local support group to recommend a qualified practitioner.

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